tbuckley/cabot-search huggingface dataset:
Abstract 11687: Diagnosis and Management of High-Risk Pulmonary Embolism in a Term Neonate
Authors: Christopher W Valle, John Kheir, Christina Ronai, Alyssa Thomas, Anne Sullivan, Catherine K Allan
Journal: Circulation (2022)

Case Presentation: A 5 day old, term infant born to a 39-year-old G1P0 with a history of diet-controlled gestational diabetes mellitus presented with hypernatremic dehydration in the setting of poor feeding. On hospital day 2, the infant suffered a bradycardic cardiac arrest requiring 2 minutes of CPR prior to return of spontaneous circulation. An echocardiogram (Figure 1A) revealed moderately depressed right ventricular (RV) function, elevated RV pressure and a large mobile mass extending from the main pulmonary artery (PA) into the left PA with obstruction of flow. D-dimer was markedly elevated at 2740 ng/mL. A subsequent CT angiogram revealed acute pulmonary emboli in the distal left and right branch PAs (Figure 1B). Additional imaging was obtained and showed dural venous sinus, left portal vein and right cephalic vein thromboses. The infant was managed with a heparin infusion and supportive therapy for the RV dysfunction and pulmonary hypertension including mechanical ventilation, inhaled nitric oxide as well as epinephrine and milrinone infusions. Over the course of two weeks, the infant improved clinically with normalization of RV function. Discussion: Neonatal pulmonary arterial thrombosis is an exceedingly rare phenomenon. The majority of cases described in the literature are associated with either an inherited thrombophilia or with underlying congenital heart disease, which were not found to be present in this case. However, this patient presented with severe dehydration and a history of maternal diabetes, both of which are risk factors for neonatal thrombosis. Fortunately, this patient responded to treatment with anticoagulation alone and did not require more invasive therapies, such as surgical thrombectomy or systemic and catheter-directed thrombolysis. Although rare, neonatal pulmonary arterial thrombosis can occur and delays in recognition and treatment may lead to significant RV dysfunction, morbidity, and even death.
Abstract 10325: Feasibility and Predictive Utility of Three-Dimensional Myocardial Deformation Analysis From Multi-Phase Computed Tomography Angiography in Transcatheter Aortic Valve Replacement
Authors: Mohamad Rabbani, Alessandro Satriano, Carmen Lydell, Mike Bristow, Ali Fatehi Hassanabad, Muhammad M Mustafa Alhussein, Zhiying Liang, Eric Tao, Anna Bizios, Corey Adams, Nowell Fine, Andrew G Howarth, William Kent, Michael W Chu, James White
Journal: Circulation (2022)

Introduction : Multi-phase computed tomography angiography (CTA) for the pre-procedural planning of TAVR presents a unique opportunity to assess 3D myocardial biomechanics. Using a novel approach, we assessed the feasibility and predictive utility of 3D myocardial deformation analysis (3D-MDA) to deliver principal strain (PS) based markers of left ventricular (LV) health for the prediction of time to heart failure hospitalization or death following TAVR. Methods: 205 patients undergoing a pre-TAVR CTA and followed clinically for &gt;6 months were identified. Whole-heart segmentation with 3D-mesh modelling was followed by 3D-MDA of the LV. 3D global LV minimum PS (minPS) was calculated for endocardial, epicardial and transmural layers. Cox regression models were performed to evaluate associations between 3D minPS and the composite outcome of all-cause mortality or heart failure hospitalization. Results: Of 205 patients, 196 (96%) had analyzable CTA data for 3D-MDA. Median (IQR) age was 85 (79.5-88) years (55% male) with median STS-PROM score 3.10 (2.10-4.55)% and median echocardiography LVEF 60 (55.9-65.0)%. Over 25 (11-36) months 55 patients (28%) experienced all-cause death or HF hospitalization. Patients with lower 3D minPS, below -23.7%, experienced a 3-fold increased risk of the primary outcome (p&lt;0.001). Following adjustment for baseline characteristics, inclusive of STS and LVEF, 3D minPS remained independently associated with the primary outcome: endocardial 3D minPS providing highest prognostic value [HR (95% CI) of 1.09 per 1% change (1.04-1.15), p&lt;0.001]. Conclusions: 3D-MDA of pre-TAVR multi-phase CTA is feasible and delivers principal-strain based markers strongly predictive of future clinical outcomes. The potential of this approach to optimize patient selection and post-procedural management requires future evaluation in a multi-centre setting.
Abstract 12176: Incidence and Risk Factors for Takutsubo Syndrome After Inpatient Chemotherapy : Nationwide Readmissions Database Analysis
Authors: Jay Parekh, Sun-Joo A Jang, Aslihan Yerlikaya, Eejung Kim, Jong Chul Park, Illhwan Yeo, Avirup Guha, Tariq Ahmad
Journal: Circulation (2022)

Backgrounds: Takotsubo syndrome (TTS) is known to be associated with malignancy. However, the exact etiology of TTS in cancer patients is still unclear. There have been several reports of TTS development from the exposure to cancer therapies. We aimed to identify risk factors for the early development of TTS among patients receiving inpatient chemotherapy or immunotherapy. Methods: Patients who were admitted primarily for chemotherapy or immunotherapy were selected from the Nationwide Readmissions Database of the United States. TTS during index hospitalization or within 30 days after discharge was identified by International Classification of Diseases - 10th Version-Clinical Modification codes. Patients who had acute coronary syndrome or coronary revascularization were excluded. Clinical and hospital characteristics in patients with or without TTS were compared. Results: Between January 2016 and November 2019, a total of 599,921 cancer patients who received chemotherapy or immunotherapy were included in the analysis. Total 295 patients (0.049%) were found to have TTS during hospitalization or within 30 days after discharge. Patients with TTS were older and more frequently had women, hypertension or chronic lung disease vs those without TTS. Leukemia was more frequent in patients with TTS (38.5%) vs in patients without TTS (24.3%) (P&lt;0.001). Multivariable risk adjustment showed that cancer type of Leukemia (adjusted odds ratio (aOR) 2.08, 95% confidence interval (CI) 1.44 to 2.99, P&lt;0.001), old age (aOR per year 1.02, 95% CI 1.01 to 1.03, P&lt;0.001), women (aOR 2.00, 95% CI 1.42 to 2.82, P&lt;0.001) and disposition to facilities (aOR 1.50, 95% CI 1.03 to 2.19, P=0.037) were independently associated with the early TTS development after inpatient chemotherapy or immunotherapy. Conclusions: The presence of leukemia, advanced age, women and disposition to facilities were significantly associated with early TTS. Further risk stratification among patients receiving chemotherapy or immunotherapy may be helpful to identify patients at risk of TTS
Abstract 12092: Natural Language Processing to Identify Reasons for Gender Disparities in Statin Use
Authors: Celeste Witting, Alban Zammit, Ashish Sarraju, Summer Ngo, Tina Hernandez-Boussard, Fatima Rodriguez
Journal: Circulation (2022)

Introduction: Statins are life-saving medications for patients with atherosclerotic cardiovascular disease (ASCVD), but women with ASCVD are persistently less likely to be prescribed statins than men. This study aims to use Natural Language Processing (NLP) to further elucidate patient and provider factors contributing to this disparity. Methods: The study cohort included patients with &gt;2 ASCVD encounters between 2014 and 2021 within a multisite electronic health record (EHR) in Northern California. Data from a random sample of our cohort (N = 942) was manually annotated to develop a benchmark deep learning natural language processing (NLP) approach, Clinical Bidirectional Encoder Representations from Transformers (BERT); 80% of these were used for model training and 20% for testing. After reviewing structured EHR data (e.g. prescriptions, allergies), BERT was used to identify and interpret discussions of statins in clinical notes. Results: Of 88,913 patients with ASCVD (mean age 67.8 ± 13.1 years), 35,901 (40.4%) were women. Women were less likely to be prescribed statins (56.6% vs. 67.6%, p &lt; 0.001). Only 18.6% of nonallergic patients without a statin prescription had a mention of statins in unstructured EHR text. Statin use through unstructured text was less likely to be identified among women than men (32.8% vs. 42.6%, p &lt; 0.001). Reasons for statin nonuse did not significantly differ by gender (Figure). Conclusions: Women with ASCVD were less likely to be use statins, and this disparity became more pronounced with the inclusion of unstructured data. An NLP approach revealed actionable reasons for statin nonuse. Future studies should leverage these approaches to monitor and track statin adherence by combining structured and unstructured data in real-world populations.
Abstract 11906: Association Between Neighborhood Environment and Physical Activity in Adults With Cardiovascular Disease in the United States
Authors: Tarang Parekh, Shubham Lahan, Zulqarnain Javed, Kershaw Patel, Miguel Cainzos Achirica, Khurram Nasir
Journal: Circulation (2022)

Introduction: Identifying attributes of the built environment that influence an individual’s adherence to recommended physical activity (PA) levels can inform cardiovascular-healthy urban-planning policies. However, no research has examined whether perceived neighborhood environment characteristics are associated with this among adults with CVD. Methods: Cross-sectional study using 2020 data from the National Health Interview Survey, which included 3191 adults with CVD. Perceived walkability and safety barriers were captured from 9 questions on participants’ feelings about the neighborhood’s safety and amenities to allow for walking. Meeting PA recommendation was evaluated based on 2012 ACC/AHA guidelines for individuals with stable CVD based on the self-reported measures of activity (Figure). Adjusted logistic models were created to evaluate the association of perceived walkability and safety with the odds of achieving PA goals. Results: In the study population, 36.8% met the overall PA guideline, of whom 7% met only strength activity, 19.5% met only aerobic activity, and 10.3% met both. Men were more likely to meet PA guidelines (42.5% vs. 29.2%) than women. In adjusted weighted analysis, having roads for a walk (OR 1.70, 95%CI 1.23-2.36), fun places such as parks, theatres, and libraries to walk near the living area (OR 1.43, 95%CI 1.08-1.89), and places to walk for relaxing and reducing stress (OR 1.46, 95%CI 1.10-1.95) were strongly associated with meeting PA recommendations. Conclusions: In adults with CVD, the neighborhood environment characteristics strongly associated with adherence to PA recommendations were the presence of places to walk for fun and relaxation. Although residual confounding is a possibility, our findings suggest that investing in social determinants by developing communities with amenities such as parks might help encourage physical activity for cardiovascular health.
Abstract 11095: Abdominal Paraganglioma: A Rare but Non-Negligible Etiology of Severe Dyspnea in Late Gestation
Authors: Hong-Jin Zhao, Yan Li, Le Yang, Hai-Tao Yuan
Journal: Circulation (2022)

With a history of cesarean delivery of a dead baby at 36 weeks of pregnancy due to severe dyspnea two years ago, a 25-year-old woman with 32 weeks of pregnancy complained severe dyspnea again and was transferred to our emergency department. Her serum test showed extremely elevated NT-proBNP. Her echocardiography exhibited normal left ventricular ejection fraction (LVEF) but diffused myocardial hypertrophy/edema, resulting in decreased inner diameters in the left ventricle and left atrium, which is quite different from other diastolic heart dysfunctions usually showing an enlarged left atrium. After emergency cesarean delivery, her cardiac walls became thinner, and the left ventricle and atrium inner diameters increased correspondingly on echocardiography along with the relieved dyspnea, but the baby did not survive either. The prominent elevation in serum norepinephrine as well as the abdominal vascular ultrasound indicated the probability of a paraganglioma below the abdominal aorta bifurcation, which was finally confirmed by pathology. However, whole exome sequencing did not exhibit the usual gene mutation reported but exhibited the RYR2 heterozygous mutation in c.2642T&gt;G, which was likely pathogenic according to bioinformatic analysis. Therefore, the severe dyspnea in her late gestation was due to the occupancy of the enlarged uterus on the paraganglioma below the abdominal aorta bifurcation, thus inducing considerable catecholamine excretion and the incidence of catecholamine cardiomyopathy (Takotsubo syndrome). To the best of our knowledge, this is the first report showing the special location of a paraganglioma exacerbated by pregnancy. The adverse pregnancy outcome emphasized the importance of the early diagnosis of paraganglioma-induced cardiomyopathy, which is rare and easily neglected by clinical obstetricians. Our case implicates that for pregnant patients with diastolic dysfunction who are contraindicated for cardiac MRI, the diffused myocardial hypertrophy/edema, especially the decreased left atrium inner diameter displayed in echocardiography, could suggest the incidence of paraganglioma-induced cardiomyopathy rather than other diastolic heart dysfunctions, such as hypertensive heart failure of pregnancy.
Abstract 11885: Optimal Timing and Prognostic Value of Follow-Up Cardiac Magnetic Resonance in Patients With Acute Myocarditis
Authors: Michele Ciabatti, Antonia Camporeale, Valentina Tavanti, Elisa Saletti, Massimo Felici, Lucia Martinese, Marco Chioccioli, Alessandra Sabini, Massimo Lombardi, Maurizio Pieroni, Leonardo Bolognese
Journal: Circulation (2022)

Background: cardiac magnetic resonance (CMR) is central for diagnosis, follow up and prognostic stratification of acute myocarditis. Late gadolinium enhancement (LGE) extent and persistence at follow-up represents a negative prognostic marker. However, time course of oedema resolution and LGE stabilization and optimal timing to repeat CMR are unclear. Hypothesis: we assessed time course of oedema and LGE evolution to identify optimal timing to repeat CMR in acute myocarditis. Methods: 36 acute myocarditis patients (35M, 28,8±10,3 years) underwent CMR at clinical presentation (CMR-1), after 3 months (CMR-2) and after 12-months (CMR-3). We assessed oedema and LGE and measured left ventricular ejection fraction (LVEF) and indexed mass (iLVM). After CMR-3 all patients were followed up yearly with clinical evaluation, Holter ECG and echocardiography. Results: all patients had oedema and LGE at CMR-1. At CMR-2 significant reduction of oedema (T2 positive segments 0,4±0,9 vs 4,1±3,2 p&lt;0.0001) and LGE (4,3±3,9 vs 7,5±5,6 p&lt;0.0001) was observed compared to CMR-1, with improvement of LVEF (62,7±5,6 vs 58,5±12,2% p&lt;0.05) and reduction of iLVM (71,2±13,7 vs 78,1±15,2 g/m2 p&lt;0.0001). At CMR-3 no further LGE reduction nor LVEF and iLVM improvement were observed. At 60±23-months follow-up, no major cardiovascular events nor myocarditis recurrences occurred. At Holter ECG 8/36 patients (28%) had non-sustained ventricular tachycardias. Ventricular arrhythmias were associated with lower LVEF at CMR-1 (46.25±19.55 vs 62.00±6.02 p=0.001) and higher LGE at CMR-2 (10.19±8.01 vs 3.60±3.14 p=0.007) but not with LGE at CMR-1 (10.05±7.14 vs 6.80±4.65 p=0.13). Conclusions: most patients with acute myocarditis present oedema resolution and LGE stabilization after 3 months. LVEF at baseline and LGE extension at second CMR correlates with ventricular arrhythmias persistence. Our findings redefine follow up and imaging-based prognostic stratification of acute myocarditis.
Abstract 127: <u>Urine Output And Mortality In Patients Resuscitated From Out Of Hospital Cardiac Arrest</u>
Authors: Dhruv Sarma, Kianoush Kashani, Jacob C Jentzer
Journal: Circulation (2022)

Background: Urine output (UO) measurement utility after out-of-hospital cardiac arrest (OHCA) survivors who undergo targeted temperature management (TTM) is not well understood. Methods: We included 247 comatose adult patients who underwent TTM after OHCA between 2007 and 2017 and excluded those on maintenance dialysis. Groups were defined based on mean hourly UO during the first 24 hours: Group 1 (&lt;0.5 ml/kg/hr, n=73), Group 2 (0.5-1 ml/kg/hr, n=81) and Group 3 (&gt;1 ml/kg/hr, n=93). Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria were used to define and stage acute kidney injury (AKI). Multivariable analysis was used to evaluate in-hospital mortality. Results: In-hospital mortality decreased as 24-hour mean UO increased (56.2% [41/73] vs 29.6% [24/81] vs 18.3% [17/93] in Groups 1, 2 and 3, respectively; adjusted OR 0.93 per 0.1 ml/kg/h higher, 95% CI 0.87-0.99, p = 0.03), and UO &lt; 0.5 ml/kg/hr was strongly associated with in-hospital mortality (adjusted OR 4.2 [1.6-10.8], p=0.003). In-hospital mortality varied by the KDIGO stage and UO group (Figure), lowest in KDIGO stage 0 and highest in KDIGO stage 3. Both UO (adjusted OR 0.92 per 0.1 ml/kg/h higher, p = 0.002) and KDIGO stage (adjusted OR 1.62 per each stage, p = 0.002) were associated with in-hospital mortality when included in the same model. Among patients with KDIGO stage 0, lower UO portended higher mortality (Figure). Likewise, among patients with low UO (group 1), a higher KDIGO stage predicted higher mortality. Conclusion: Amongst OHCA survivors undergoing TTM, higher UO is incrementally associated with lower in-hospital mortality. The lowest mortality was observed at UO &gt;=1 ml/kg/h, suggesting this as a target for resuscitation in OHCA patients undergoing TTM. Low UO remains associated with in-hospital mortality even when accounting for AKI by creatinine criteria, suggesting that oliguria is a more sensitive prognostic marker in the early post-OHCA phase.
Abstract 11804: Improved Recovery Times and Postoperative Outcomes After Cardiac Surgery Done Under Thoracic Epidural Anaesthesia: A Systematic Review, Meta-Analysis, With Trial Sequential Analysis
Authors: John K Chiew, Christopher J Low, Kieran Zeng, Zhi Jie Goh, Ryan R Ling, Ying Chen, Lian Kah Ti, Kollengode Ramanathan
Journal: Circulation (2022)

Background: Research on fast-track recovery protocols postulate epidural anaesthesia (TEA) in cardiac surgery contribute to improved postoperative outcomes. However, concerns about TEA’s safety and current equivocal evidence, hinder its widespread usage. We conducted a systematic review and meta-analysis to assess the effects of TEA in cardiac surgery. Methods: We searched four databases for randomised controlled trials (RCTs) assessing the use of TEA against only GA in adults undergoing cardiac surgery, up till 4 June 2022. We conducted random effects meta-analyses (DerSimonian and Laird), evaluated risk of bias using the Cochrane Risk-of-Bias 2 tool, and rated certainty of evidence via the GRADE approach. Primary outcomes were ICU and Hospital length of stay, with other outcomes including postoperative complications. Trial sequential analysis (TSA) was conducted on all outcomes to elicit statistical and clinical benefit. Results: Our meta-analysis included 39 RCTs (1941 TEA patients, 2047 GA patients). TEA significantly reduced ICU LOS (Figure 1: -6.8 hours, 95%-CI: -10.8 to -2.8, p=0.0009), hospital LOS (-0.7 days, 95%-CI: -1.2 to -0.2, p=0.0051), and extubation time (-2.8 hours, 95%-CI: -3.8 to -1.8, p=0.0001). However, there was no significant reduction in mortality. TSA found that the cumulative Z-curve passed the TSA-adjusted boundary for ICU LOS (see below), hospital LOS, and ET, suggesting a clinical benefit. TEA also significantly reduced transfusion requirements, pain scores, delirium, arrhythmia, and pooled pulmonary complications, without additional complications such as epidural hematomas. Conclusions: TEA reduces ICU and hospital lengths of stay, and postoperative complications in patients undergoing cardiac surgery with minimal reported complications. These findings favour the use of TEA in cardiac surgery, and warrants consideration for use in cardiac surgeries worldwide.
Abstract 10885: Integrin β <sub>3</sub> Directly Inhibits Galpha <sub>13</sub> -p115rhogef Interaction and Its Role in Regulating Platelet Exocytosis
Authors: Yaping Zhang, Xiaoping Du
Journal: Circulation (2022)

G protein-coupled receptors (GPCRs) and adhesion receptor integrins are fundamental to a cell’s response to extracellular stimuli. GPCRs, through Gα q and Gα i , activate integrins and, through the Gα 13 -p115RhoGEF-RhoA pathway, stimulate contractility and integrin-independent exocytosis (granule secretion). Gα 13 also interacts with integrins and mediates outside-in signaling, cell spreading and integrin-dependent exocytosis. However, it was unknown whether there was crosstalk between integrins and the Gα 13 /p115RhoGEF-mediated RhoA signaling pathway. It was also unclear with the role of Gα 13 -integrin interaction in regulating GPCR- and integrin- mediated platelet exocytosis. In this study, we demonstrate that binding of the integrin β 3 cytoplasmic domain to Gα 13 through its ExE motif, directly disrupts the interaction between p115RhoGEF and Gα 13 , thus inhibiting Gα 13 -p115RhoGEF-mediated RhoA activation and signaling. In platelets, this inhibitory effect of integrins greatly reduces GPCR-mediated integrin-independent granule secretion. On the other hand, the Gα 13 -integrin interaction stimulates integrin outside-in signaling and integrin-dependent granule secretion. Furthermore, we demonstrate that the inhibitor peptide derived from the Gα 13 -binding β 3 ExE motif disrupts the β 3 -Gα 13 interaction to inhibit GPCR-induced integrin-independent granule secretion and also inhibits outside-in signaling and integrin-dependent granule secretion. This dual effect results in robust inhibition of granule secretion without affecting primary platelet aggregation, suggesting a new therapeutic approach for the development of selective inhibitors of platelet granule secretion. In conclusion, we have discovered a mechanism underlying direct integrin-GPCR crosstalk that regulates the Gα 13 -p115RhoGEF-RhoA signaling pathway. Our data also demonstrate an approach to potently inhibit platelet granule secretion without impairing primary platelet adhesion/aggregation and hemostasis.